Find the cause first
The assessment checks your glasses prescription, eye surface, cornea, lens position, capsule and retina. Dry eye, residual astigmatism, capsule clouding or macular swelling may need different treatments.
IOL exchange and
complex cataract surgery
Cataract care for eyes with retinal disease, previous surgery or more complex needs, and the exchange of an intraocular lens (IOL) that is no longer serving the eye.
Why does retinal experience matter for complex cataract surgery?
Dr Chen regularly receives complex cataract referrals, including eyes with retinal disease, trauma or complications from previous surgery, and eyes in which the lens implant has moved or needs to be exchanged.
What makes a cataract complex?
Retinal context
How coexisting retinal disease, a membrane or previous vitrectomy affects lens choice, timing and expectations.
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Lens stability
Assessment of lens position and the support available for a lens when the usual pathway is more complicated.
Previous surgery or injury
Understanding what has already happened, including laser vision correction or trauma, before planning the next step.
How does Dr Chen manage complex cataracts and their complications?
Why an eye may be complex
- Weak lens support or a dislocated lens can follow an eye injury, previous surgery or pseudoexfoliation (a condition that can weaken the fibres holding the lens in place).
- Dr Chen brings cataract and retinal surgery expertise to these complex eyes.
Experience with complications
- Other eye surgeons regularly refer patients to him to manage complications of cataract surgery.
- These include lens material or an artificial lens that has fallen into the back of the eye and requires treatment by a retinal surgeon.
- For patients whose cataract surgeon does not perform retinal surgery, these complications can mean referral to another surgeon and a further operation.
Skills, equipment and support
- Dr Chen has the specialist skills to provide that treatment himself.
- He operates in theatres equipped for both cataract and retinal surgery, with nurses trained to assist with these procedures and use the specialist equipment.
- Selected complications that arise during surgery can be treated in the same operation when appropriate, potentially avoiding referral to another surgeon and a separate procedure.
- Treatment and timing are tailored to your eye, including whether a combined or staged approach is preferable.
Where can I read more about these operations?
Dr Chen has written about two of them for other eye surgeons in Cataract & Refractive Surgery Today.
Pearls for the Yamane Technique
Dr Chen’s step-by-step tips for the Yamane technique, which fixes a replacement lens to the wall of the eye without stitches when the lens’s natural support has been lost.
Read the articleDropped Nucleus: Management Tips from a Retina Surgeon
Dr Chen’s guidance on managing part of the cataract falling into the back of the eye during surgery, one of the most feared complications of cataract surgery.
Read the article
Can an intraocular lens be exchanged?
An intraocular lens (IOL) is the artificial lens placed in the eye during cataract surgery or refractive lens exchange. Occasionally it needs to be repositioned or replaced.
The reasons vary: a lens power or design that has not suited the eye, a lens that has moved because the capsule or its supporting fibres have weakened, damage or clouding of the lens material, or the aftermath of earlier surgery. IOL exchange is a more involved operation than first-time cataract surgery, particularly when the capsule can no longer hold a lens and the new one has to be fixed to the wall of the eye by a technique such as Yamane or sutured fixation.
Dr Chen performs IOL exchange and secondary lens fixation, and sets out the options for each eye in plain language, including when leaving a lens in place is the wiser course.
What equipment is used for lens exchange and lens fixation?
Lens exchange and repositioning call for dedicated instruments. Dr Chen’s practice has:
- specialised fine microsurgical forceps for handling, repositioning and removing lens implants;
- dedicated equipment for scleral fixation, which fixes a lens to the white of the eye when its natural support has been lost, using the stitchless Yamane flanged-haptic technique or sutured scleral fixation;
- piggyback lenses such as the Sulcoflex and 1stQ AddOn, which sit in front of an existing implant;
- custom-made high-power lenses for eyes whose measurements fall outside the range of standard lenses.
- An IOL is the artificial lens placed at cataract surgery or RLE
- Exchange is considered for an unsuitable, damaged, clouded or dislocated lens
- The new lens may sit in the capsule, in front of it, or be fixed to the wall of the eye
- More involved than first-time surgery; risks and predictability differ
- Sometimes the right decision is to leave the lens alone
What if my vision is not right after cataract surgery?
Blur, haloes or difficulty at night deserve a careful assessment. These symptoms do not automatically mean the implant needs replacing.
Describe the visual disturbance
Explain when symptoms occur, whether glasses help and whether they are improving. Bright rings or streaks and a dark arc at the edge of vision are different problems. A new shadow or curtain needs urgent retinal assessment.
Consider the alternatives
Depending on the cause, options may include treating dry eye, glasses, time for healing or adaptation, capsule laser, repositioning the implant or lens exchange. Selected eyes may be considered for corneal laser or a supplementary lens; suitability requires individual assessment.
Balance improvement against risk
Changing a lens means another operation inside the eye. The capsule’s strength, previous surgery and retinal health affect the approach and risk. A different lens may reduce one symptom while increasing the need for glasses.
Why might a lens implant need exchanging?
- A lens power or design that has not suited the eye, for example haloes or glare from a multifocal lens
- A lens or its supporting capsule that has moved (a dislocated or unstable lens)
- Damage to the lens, or clouding of the lens material
- Complications of earlier surgery that call for a different lens
Where can a replacement lens be placed?
- In the capsular bag, when the original support is sound
- In front of the capsule, in the sulcus, when the bag cannot hold a lens
- Fixed to the wall of the eye without stitches (the Yamane technique) or with sutures (sutured fixation)
- Occasionally fixed to the iris
What are the risks of lens exchange?
- A more involved operation than first-time cataract surgery, with a longer recovery
- Risks include retinal detachment, raised pressure, corneal swelling, bleeding and the need for further surgery
- The final focus is less predictable than in routine cataract surgery
- Sometimes the better decision is to leave a lens in place
How is the eye assessed before lens exchange?
The assessment looks at both the front and the back of the eye, because both shape the plan.
The position of the existing lens and the support left in the capsule are examined through a dilated pupil, sometimes with imaging of the front of the eye. The cornea is measured and its health checked, since exchange surgery asks more of it. An OCT scan (optical coherence tomography) of the macula and a full retinal examination establish what the retina can be expected to deliver, and whether a retinal procedure should be combined with the lens surgery.
Dr Chen explains what he found, the options that are realistic for that eye, and what to expect from each, including the recovery and the limits on predictability.
What should I bring?
- Details of any previous eye surgery, including the lens implanted if you have them
- Your referral and any previous scans
- Current glasses
- A list of medications, including blood thinners
- Someone to drive you home; the drops blur vision for several hours
What should I ask Dr Chen about lens exchange?
- What makes my cataract more complex, and how does that change the plan?
- If my lens implant is being exchanged: why, and what will the new lens be?
- Where will the new lens sit, and what does that mean for the operation?
- What are the risks for my eye in particular, including to the retina?
- How predictable is the focus afterwards, and what may take longer to settle?
- Is more than one operation likely?
- Is there anything about my history that you need in more detail?
Common questions about lens exchange and complex cataract
Can a lens implant be exchanged years after cataract surgery?
Sometimes, yes. The capsule and the eye change with time, so the assessment looks carefully at what support remains. Whether exchange is sensible, and what the new lens should be, is decided eye by eye.
What is a dislocated lens?
The implant, or the capsule holding it, has moved from its usual position, often because the fibres that support the capsule have weakened. Vision becomes unstable or blurred. Options range from leaving a mildly displaced lens alone to repositioning or replacing it.
Why is my cataract described as complex?
Common reasons include previous eye surgery or injury, a very dense cataract, a weak capsule, a small pupil, high short-sightedness or coexisting retinal disease. Each changes the planning, the technique or the expectations.
Will the retina be checked before surgery?
Yes. Dr Chen assesses the lens and retina together and can plan treatment for both.
Some cataract and retinal procedures can be combined in one operation; others are best staged. The approach depends on your retinal condition and the needs of your eye.
Will a lens exchange remove all glare or haloes?
It may help when the implant is responsible, but cannot guarantee that every symptom will resolve. The eye surface, cornea and retina can contribute, and some symptoms settle with healing or adaptation. The likely benefit and remaining need for glasses are discussed before deciding.
Where can I read more?
Longer articles by Dr Chen go into these questions in more detail, including what the research shows.
Can a lens implant be replaced after cataract surgery? What is the Yamane technique for fixing a lens implant? How do I choose a cataract surgeon in Sydney? Cataract surgery after LASIK, PRK or SMILE: what changes in planning? Cataract care Tamsulosin and cataract surgery: what should you tell your surgeon?
How do I make an appointment with Dr Chen to discuss complex cataract surgery or lens exchange?
Appointments and enquiries are made through Vision Eye Institute Chatswood.
Level 3, 270 Victoria Avenue, Chatswood NSW 2067For referrers
Optometrists, GPs and ophthalmologists can refer through Oculo or with the PDF referral form.
Vision Eye Institute confirms your appointment after you submit your request. The request form is not for emergencies. A referral is not strictly essential to request an appointment, but you need a valid one to claim a Medicare rebate for your consultation.